HomeMy WebLinkAboutPermit Renewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST
PERNUTNUMBER: / 8-6 7— ADDRESS: I � IIA k/ R 3'ig93
I, ym 1 ke— E�S- , am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
6WNERN DR OR CONTRACTOR SIGNATURE DATE
Iml.ke Es;k�
Prmt Name
STATE OF FLORIDA
COUNTY OF 5 " 11Lr'h
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY Y1 �� �i WHO IS PERSONALLY KNOWN TO ME LOR
HAS PROVIDED
STATE Of FLORIDA, County of
SIMATCTRP, OF NO
�&
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
AS IDENTIFICATION.
SEAL
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014